Increased prevalence of impaired hearing in patients with type 2 diabetes in western India

In an out-patient study of 1344 general medical patients over 50 years old in India, the prevalence of hearing aid use was found to be significantly greater in type 2 diabetics.

Postural differences in cardiac dynamics during quiet and active sleep in low birthweight infants

To study the effects of body position (supine versus prone) on changes in cardiac inter-beat interval during quiet and active sleep, 6-h continuous electrocardiographic recordings and simultaneous minute-by-minute behavioural activity state assignments were made in 61 healthy, growing, low birthweight infants. The infants weighed 795-1600 g at birth and ranged between 30-38 wk in postconceptual age. Infants were randomly assigned to the supine or prone position for the first 3 h of each study; the position was reversed for the second 3 h. Higher heart rates and lower time and frequency domain measures of inter-beat interval variability were observed in the prone position as compared to the supine position, during both quiet and active sleep. In addition, an analysis of consecutive increases and decreases in the instantaneous heart rate revealed a lower incidence of sustained accelerations or decelerations in the prone position. Although consistent findings concerning inter-beat interval variability and sleeping position were obtained from all analytic techniques, the differences derived from analysis of consecutive inter-beat changes were the most robust. These differences in multiple measures of cardiac rate and rhythm between prone and supine positions suggest that autonomic control of the heart is altered by body position, the net effect on heart rate being increased sympathetic dominance.

Retrobulbar optic nerve cysticercosis with surgical removal: a case report

A 15-year-old boy presented with diminution of vision which rapidly progressed to no perception of light. In the ocular fundus, a neuroretinitis-like picture was seen. On CT-scan & ultrasonography, an optic nerve swelling was detected with a shadow of scolex. Medical therapy in the form of steroids along with albendazole was ineffective. Surgical removal by lateral orbitotomy was done and a complete cyst with scolex was removed, which was confirmed histopathologically as a case of retrobulbar optic nerve cysticercosis.

Effect of fiberoptic bronchoscopy on arterial blood gases and cardiac rhythm at a moderate altitude of 2250 meters

OBJECTIVES

To study the effects of fiberoptic bronchoscopy (FOB) at an altitude of 2250 m on arterial blood gases (ABG) and cardiac rhythm abnormality.

METHODS

Fifty consecutive patients undergoing fiberoptic bronchoscopy were evaluated for the arterial blood gases and cardiac rhythm changes at Shimla (a moderate altitude of 2250 m), where there is a state of ambient hypoxia.

RESULTS

The changes were noted in five stages ranging from the levels before the procedure till 15 minutes after the completion of the procedure. The mean fall in PaO2 levels in this study was 8 +/- 2.45 mm Hg and the fall was maximum at the end of procedure. Both smokers and nonsmokers showed a significant fall but the fall was more severe in smokers. The mean fall in SaO2 in this study was 3%. The increase in heart rate and blood pressure during FOB was significant as compared to baseline levels. There was no significant change in PH, PaCO2, HCO3. The commonest rhythm abnormality noted was sinus tachycardia which was well tolerated. No major cardiac arrhythmia was noted. It was further seen that the duration of the procedure and type of special procedure undertaken did not effect the levels significantly. Cyanosis was the commonest complication encountered (36%) and was seen more frequently in smokers and those with age more than 40 years. It was observed during the induction of bronchoscope and also during the further negotiation of the bronchoscope into the smaller branches of bronchial tree.

CONCLUSION

The changes in ABG and cardiac rhythm are comparable to the studies at sea level except the increased incidence of cyanosis.

Effectiveness of salmeterol in stable COPD

Thirty patients of stable chronic obstructive pulmonary disease (COPD) were studied for evaluation of effectiveness of inhaled salmeterol in a double blind, randomised, placebo controlled trial for seven days. Baseline spirometery and breathlessness score after 6 minutes walk test were assessed in all patients. Bronchial asthma was excluded in each patient by reversibility test with 200 ug of salbutamol inhalation. After inhalation of two puffs from a given inhaler through spacer device in the morning, spirometery was carried out 1, 3, 6 and 12 hrs after inhalation on day 1, 3 and 7 of trial. Six minutes walk test and breathlessness score were assessed after 3 hrs of inhalation on days 1, 3 and 7. The maximum bronchodilator response to salmeterol was observed on 7th day at three hours after inhalation. The mean increase in FEV1 was 29.2% of baseline value, which was significant as compared to placebo where the mean increase in FEV1 was 3.3% of the baseline value. The peak rise in FEV1 was observed at three hours after inhalation on all the three days. The bronchodilator effect of salmeterol persisted for upto 12 hours. The mean maximum increase in walking distance in 6 minutes walk test was observed on 7th day in salmeterol group, which was 50.7 metres whereas in placebo group it was 12.2 meters. The patients in salmeterol group perceived less breathlessness after the six minutes walk test. The study concluded that salmeterol 50 micrograms twice a day is effective in improving lung functions in patients with stable COPD and can be recommended as maintenance therapy for stable COPD patients.

Body position, sleep states, and cardiorespiratory activity in developing low birth weight infants

The objective of this study was to determine the effects of body position (supine vs prone) on cardiorespiratory activity during quiet and active sleep in growing low birth weight (LBW) infants. The effect of postconceptional age on cardiorespiratory activity in the two positions was also evaluated. Fifty-one healthy, growing, appropriate for gestational age LBW infants (795-1600 g), ranging from 26-37 weeks in gestational age, were evaluated. All subjects were enrolled in an ongoing study of the effects of quality of dietary energy on the rate and composition of weight gain. Infants were randomly assigned to the supine or prone position for the first 3 h of the 6-h studies; the position was reversed for the second 3 h. Continuous recordings of cardiorespiratory activity were performed along with simultaneous minute by minute assignment of behavioral sleep state. Measurements of heart rate (HR), heart period variability (RR-SD), respiratory rate (f), and respiratory variability (fSD) were made each minute. Low birth weight infants had higher HR and f and lower RR-SD and fSD in the prone position compared to the supine position, during both quiet and active sleep. With increasing postconceptional age, positional differences in HR increased during quiet sleep and differences in RR-SD increased during both sleep states. These data demonstrate systematic differences in cardiorespiratory control related to body position during sleep. We speculate that such positional differences are due to variations in autonomic control, and may, in turn, contribute to variations in susceptibility to sudden infant death syndrome.

Spectrum of cystic variants of Wilm's tumour: cystic nephroma (multilocular cyst) and cystic partially differentiated nephroma--a report of four cases

Two cases of cystic nephroma (multilocular cyst of the kidney), and one case each of cystic partially differentiated nephroblastoma (CPDN) and rhabdomyomatous Wilms' tumour are described. All were male and in the pediatric age group. Grossly tumours were unilateral, unicentric and multiloculated. The need for proper designation of these lesions is highlighted because of difference in the treatment and prognosis of these tumours.

Flotation characteristics of cyanobacterium Anabaena flos-aquae for gas vesicle production

Cyanobacterium Anabaena flos-aquae was cultivated in photobioreactors for production of intracellular gas vesicles (GVs), as potential oxygen microcarriers. Natural flotation of the buoyant culture was investigated as a potential means of cell harvesting, because filtration and centrifugation tended to destroy the vesicles. Best flotation was found with actively growing culture and when conducted in the dark. The flotation-related cell properties, including the specific GV content, vesicle-collapsed filament density, and intracellular carbohydrate content, were measured to understand the phenomena. During the batch culture, the specific GV content remained relatively constant at 370 microL/(g dry cells) but the filament density (ranging 1.02 to 1.08 g/cm3) showed a decrease-then-increase profile. The increase began when the growth slowed down because of the reduced light availability at high cell concentrations. The dark flotation was studied with both actively growing (mu approximately 0.2 day-1) and stationary-phase cultures. The specific GV content of the stationary-phase culture remained relatively constant while that of the growing culture increased slightly. The intracellular carbohydrate content of the growing culture decreased much faster and more significantly, from 57 to 10 mg/(g dry cells) in </= 8 h. The filament density also decreased, apparently parallel to the profiles of carbohydrate content.

Gastrointestinal mucormycosis--an uncommon isolated mucormycosis

BACKGROUND

Isolated mucormycosis of the gastrointestinal tract is uncommon, with only two case reports from India.

OBJECTIVES

To study the clinicopathologic features of gastrointestinal mucormycosis in Indian patients.

METHODS

Eight cases of isolated gastrointestinal mucormycosis, seen over six years (1992-97) are reviewed.

RESULTS

Five of the patients were premature babies or infants, one was a 12-year-old boy, and two were middle aged. Symptomatology included vomiting, bloody diarrhea, upper gastrointestinal bleeding, abdominal lump and abdominal distention. All the neonates presented with intestinal perforation. The duration of symptoms was ten days or less in six cases. Mucormycosis was not suspected clinically in any patient. In six cases the diagnosis was established antemortem from resection or biopsy material. Only two patients received antifungal therapy and only one patient responded.

CONCLUSIONS

Isolated gastrointestinal mucormycosis is not uncommon in India. Early diagnosis may be helpful in reducing the high mortality.

Prevalence of atherosclerosis risk factors in adolescent school children

The emerging epidemic of atherosclerotic cardiovascular diseases in developing countries may have its roots in childhood. We studied atherosclerosis risk factors--tobacco use, obesity, hypertension, total cholesterol level and dietary intake of atherogenic nutrients in adolescent school children aged 13-17 years in Western India. Two hundred thirty-seven children (89 boys, 148 girls) were examined and prevalence of risk factors determined. Family history of coronary heart disease was found in 16 (6.8%), smoking or tobacco use in one (0.4%) and obesity (BMI > 90th percentile) in 24 (10.1%), borderline hypertension (> or = 136/86) in 65 (27.4%) and definite hypertension (> or = 142/92) in 17 (7.2%). Borderline hypercholesterolaemia (170-199 mg/dL) was in 78 (32.9%) and definite hypercholesterolaemia (> or = 200 mg/dL) in 16 (6.8%). Mean calorie intake was 1450 +/- 348 per day. Fats provided 38.4 +/- 8 percent of the calories, saturated fats contributed to 20.3 +/- 6.4 percent of calories, monounsaturated fats to 12.9 +/- 2.4 percent and polyunsaturated fats to 5.0 +/- 3.7 percent. Dietary cholesterol intake was 164 +/- 95 mg/day, sodium chloride intake 12.8 +/- 5.7 gm/day and fibre intake 6.5 +/- 4.6 gm/day. This study shows a high prevalence of metabolic and dietetic coronary risk factors among adolescents of the middle- and upper-middle class in India.

Adrenal lipoma. A case report

Lipoma of the adrenal gland is an extremely uncommon tumor detected incidentally at postmortem or during life when the patient undergoes investigations for other reasons. All tumors reported in the literature were very small in size. We report a case of lipoma of the adrenal gland in a 45-year-old male patient who was hypertensive and presented with pain in the abdomen. The symptomatic presentation, large size, laparoscopic removal and rarity of this tumor merit documentation in the literature.

Nucleolar organiser regions and morphologic subtypes of squamous cell carcinoma of cervix

Nucleolar organiser regions (NOR) are chromosomal segments coding for ribosomal RNA. The number of nucleolar organiser regions correlates with cellular proliferation and has a diagnostic and prognostic value in neoplastic diseases. The aim of this study was to study the morphologic subtypes of squamous cell carcinoma of the uterine cervix in biopsy and hysterectomy specimens and to determine the AgNOR counts in these morphologic subtypes. One hundred and seventy-nine cases of squamous cell carcinoma of the uterine cervix were classified into three morphological subtypes namely large cell non keratinising squamous cell carcinoma (113), keratinising squamous cell carcinoma (64) and small cell carcinoma (2). A correlation of histologic typing on biopsy and hysterectomy specimens was done in 142 cases with a complete correlation in 90.5%. Fifty-eight of these tumours were stained with silver nitrate to demonstrate Nucleolar organiser regions (AgNORS). The mean AgNOR count was higher (3.66) in keratinising squamous cell carcinoma, which is known to have a worse prognosis as compared to 3.04 in large cell non keratinising carcinoma and (3.45) in the two cases of small cell carcinoma of the uterine cervix.